Epidemiology and management of nontuberculous mycobacterial disease in people with cystic fibrosis, the Netherlands

Background: Nontuberculous mycobacteria (NTM) are opportunistic, difficult to treat pathogens. With increasing prevalence of NTM infections in people with cystic fibrosis (pwCF) and the improved life ex-pectancy, the burden is expected to grow. Methods: We assessed the epidemiology and management of NTM isolation and disease in pwCF in the Netherlands using a survey and retrospective, case-controlled data from the Dutch CF Registry. We deter-mined the isolation prevalence, treatment and outcomes from 2013-2019.Results: NTM isolation prevalence increased from 1.0% to 3.6% (2013-2019). This was a single NTM iso-lation in 53.7% of the adults and 60.0% of the children. M. abscessus and M. avium complex (MAC) were most frequent (47.1 and 30.9%). Of the treated pwCF, 48.5% attained culture conversion of M. abscessus; 54.5% for MAC. Children with an NTM isolation showed more infections with S. maltophilia and/or A. fu-migatus ( p < 0.001) compared to controls. In the year prior to NTM isolation, children in the NTM group had a lower mean FEV1% predicted (81.5 +/- 16.7 vs. 88.6 +/- 15.3, p = 0.024), while adults in the NTM group had more IV antibiotic days compared to controls (60 vs. 17, p = 0.047). In the following years, FEV1% predicted declined faster in pwCF with NTM than the control group (children:-3.8% vs.-1.6%, p = 0.023; adults:-0.7% and 0.4%, ns).Conclusions: The isolation prevalence of 3.6%, poor treatment outcomes and associated lung function decline emphasize that NTM pulmonary disease (NTM-PD) is a significant health issue among pwCF in the Netherlands. Its prevention and treatment require increased attention.(c) 2022 The Author(s). Published by Elsevier B.V. on behalf of European Cystic Fibrosis Society. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Automated summary

A survey and retrospective data analysis from the Dutch CF Registry were conducted to assess the epidemiology and management of NTM isolation and disease in pwCF in the Netherlands. The study revealed an increasing prevalence of NTM isolation, poor treatment outcomes, and an association with declining lung function. The prevention and treatment of NTM pulmonary disease among pwCF in the Netherlands require increased attention.